Provider Demographics
NPI:1801365028
Name:HANF, LYLE MARIE
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:MARIE
Last Name:HANF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 LA MIRADA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1728
Mailing Address - Country:US
Mailing Address - Phone:626-676-6428
Mailing Address - Fax:
Practice Address - Street 1:724 LA MIRADA AVE
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1728
Practice Address - Country:US
Practice Address - Phone:626-676-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist